Experience with helicopter rescue missions for crevasse accidents

We retrospectively studied incidence, patterns, and severity of injury and hypothermia in 95 victims of crevasse accidents. Fifteen (16%) victims were already dead when the rescue team arrived on the scene. Asphyxia (8 victims) was typically caused by snow burial owing to a collapse of snow bridges covering crevasses and was observed only during winter sports activities on glaciers. In 7 patients, death was caused by lethal trauma. Severe or critical multisystem trauma (ISS ≥ 16) was found in an additional 16 victims (17%). Severe or critical injuries were predominantly thoracic injuries and injuries of the extremities and/or pelvic region. Severe accidental hypothermia was observed in 9 of the 95 victims (10%). Three of these suffered from hypothermic sudden cardiac arrest during rescue and were immediately evacuated with ongoing CPR; all 3 made a full recovery after extracorporeal rewarming. More than two-thirds of all victims were still trapped in the crevasse when the rescue team arrived. However, the majority of them could be relatively easily extricated using standard mountaineering equipment and improvised rescue techniques. Prolonged and difficult extrication efforts were needed in less than 10% of victims. Summing up, trauma and asphyxia are the most important causes of mortality and acute life-threatening medical problems in this study, but asphyxia will be far less common in mountain regions offering fewer glacier sport activities in the winter months. Hypothermic sudden cardiac arrest could not be prevented during the difficult conditions of crevasse extrication in one-third of all hypothermic victims; however, prognosis was excellent with advanced life support at the scene and immediate helicopter evacuation to extracorporeal rewarming.